Resp Care
-
The measurement of esophageal and gastric pressures with balloon-tipped catheters has been used with great success over the past half century to delineate the physiology of the mechanical respiratory system. Pleural pressure and abdominal pressure values estimated from esophageal and gastric pressure measurements allow analysis of lung and chest wall compliance, as well as work of breathing, respiratory muscle function, and the presence of diaphragm paralysis. ⋯ In this article I review the historical background, physiology, placement techniques, and potential clinical applications of esophageal and gastric pressure measurements. In addition, I will briefly review the measurement of bladder pressure, which is a related topic.
-
Disposable manual resuscitators are commonly used to ventilate patients during cardiopulmonary resuscitation, suctioning, and intrahospital transport, and their clinical performance is critical. ⋯ Resuscitator reservoir style and manufacturer design significantly affect FDO2. Some resuscitator models may not deliver adequate oxygen in certain clinical circumstances. Each institution should evaluate and choose the resuscitator that best fits its needs, while meeting established performance criteria.
-
We report a case of a previously healthy 41-year-old man who was admitted for progressive dyspnea and cough, which culminated in respiratory failure, shock, and death. Lung and muscle biopsy results were consistent with interstitial lung disease secondary to polymyositis. Polymyositis and dermatomyositis are rare autoimmune diseases that primarily affect the muscles and skin, with frequent extramuscular and specifically pulmonary manifestations. ⋯ Diagnosis of a specific interstitial lung disease relies mainly on high-resolution computed tomography of the chest and on tissue diagnosis. Prognosis depends on the histopathology findings and the specific form of interstitial lung disease and its response to therapy, which consists of high-dose steroids and immunomodulating agents. Unfortunately, patients with polymyositis/dermatomyositis associated with pulmonary complications have a worse prognosis than patients with isolated forms.
-
The utility of routinely obtaining arterial blood gas analyses (ABGs) prior to extubation in patients who have successfully completed a spontaneous breathing trial is not known. ⋯ ABG measurement does not appear to be a prerequisite to extubation following a clinically successful spontaneous breathing trial.
-
Previous in vivo data suggest that high airway resistance (R(aw)) promotes dynamic hyperinflation, especially when coupled to high minute ventilation (V(E)). However, no studies have systematically examined the relative effects of various mechanical parameters on dynamic hyperinflation. ⋯ In this bench model, dynamic hyperinflation occurred with high V(E), even at low R(aw). Since moderate R(aw) and V(E) frequently occur in vivo, even without obstructive lung disease, occult dynamic hyperinflation is likely to occur commonly. PEEPi was greater with high frequency and small tidal volume (0.6 L) than with equal V(E) of lower frequency and larger tidal volume (1.0 L).